Enrolment and Change Form

The Enrolment and Change Form is used by newly eligible employees in the insurance plan; as well as by those on the plan who are making changes to the original enrolment information. First time enrolees must complete all sections, except for the Dependent Coverage if they are not electing Family Basic Coverage. The Authorization section must always be completed.

All changes in your coverage can also be made on this form. This includes changing coverage, adding or deleting a dependant, changing the status of your eligible child age 21 or older to fulltime student, changing your name, changing your address, changing your beneficiary, or changing your Co-ordination of Benefits (coverage through your spouse’s employer or your fulltime student’s university coverage).

If you are enroling more than 31 days from your date of hire (contract date) or date you first became eligible, you must complete a Statement of Health. This will be submitted to Manulife to determine if your health condition will qualify you for coverage.

Retirees may enrol by obtaining an Enrolment and Change Form from the website or contacting CSI for an enrolment form.




Optional Life Coverage

The Optional Life Application Form is used by new,eligible employees to enrol or increase life insurance for employees and their spouses who are already on the plan.

The Manulife Optional Life Evidence of Insurability Form must be completed if requesting more than $10,000 of Optional Life or increasing the current amount of Optional Life. Additionally, Optional Life requests for spouses require an Evidence of Insurability Form.  Requests must be approved by Manulife to qualify for this coverage. If requesting just $10,000 of Optional Life within 31 days of the date of hire, only the Optional Life Application Form is needed




Critical Illness Coverage

The Optional Critical Illness Coverage Application Form is used by new, eligible employees to enrol in this program which supplements your coverage to reduce the potentially devastating impact that 22 covered conditions may cause. Use this enrolment form if you are applying for $25,000 or less for you and/or your spouse. You may also apply for $5,000 of coverage for your child(ren).

If you are enrolling for amounts greater than $25,000, or if you are enrolling later than 30 days from your date of hire (contract date) or date you first became eligible, you must complete the Optional Critical Illness Application Form and the Manulife Critical Illness Evidence of Insurability Form.This will be submitted to Manulife to determine if your health condition will qualify you for the coverage.




Claim Forms

Manulife must be notified of address changes for health and dental claims.

The following forms are to be used when submitting health and dental claims to Manulife:




Work Stoppage Form

Insurance may continue during a leave of absence upon approval from CSI and/or Manulife. The Work Stoppage Form must be completed by an authorized person at your school. Details about coverage during a leave of absence is outlined in CSI’s Update 310.




Short Term Disability Application Form

The following forms are used to apply for Short Term Disability and must be completed after a disability has begun:




Long Term Disability Application Forms




Co-op Student Insurance Registration Form

The Co-op Student Insurance Registration Form is used to enrol high school students who are involved in a co-op arrangement. It can also be used for university or college students during their practicum.




International Student Insurance Enrolment Form

The International Student Insurance Enrolment Form is used to enroll international students for coverage while they are living in Canada and attending school.




Employer Work Information Form

The Employer Work Information Form is used to assist Manulife Financial in the adjudication of a Short Term Disability Claim. This form should be completed ONLY when requested by the CSI Canada Insurance office.